Provider Demographics
NPI:1083138390
Name:VALLEY COMMUNITY COUNSELING CLINIC
Entity Type:Organization
Organization Name:VALLEY COMMUNITY COUNSELING CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CALLAE
Authorized Official - Middle Name:
Authorized Official - Last Name:WALCOTT-ROUNDS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:818-763-2084
Mailing Address - Street 1:6400 LAUREL CANYON BLVD STE 260
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-1562
Mailing Address - Country:US
Mailing Address - Phone:818-763-2084
Mailing Address - Fax:
Practice Address - Street 1:6400 LAUREL CANYON BLVD
Practice Address - Street 2:SUITE 260
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606
Practice Address - Country:US
Practice Address - Phone:818-763-2084
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)